Plug it, fill it and forget it!

Background: Management of posterior scleral perforation is commonly done with cryotherapy/laser or scleral patch graft depending on the size of perforation. However, for large perforations, the availability of donor sclera is always an issue. To overcome this problem, we tried using absorbable gelatin sponge to plug the perforation as an alternative. Purpose: To evaluate the efficacy of gelatin foam as an alternative to scleral patch graft in cases with perforation of posterior sclera. Synopsis: Here we report the case of a 27?year?old male, who sustained penetrating injury to right eye with two metallic intraocular foreign bodies with visual acuity of hand movement close to face. Primary wound repair was done, followed by retrieval of the first piece of metallic foreign body that measured 11X3mm in size. The second foreign body visualized at posterior pole adjascent to the disc was removed using Machemar forceps and it measured 10X3 mmin size. Leakage of PFCL at the site confirmed a posterior scleral perforation. Cryotherapy was avoided due to its proximity to optic nerve head, and donor sclera was not readily available at that moment. We managed the case by plugging the defect with absorbable gelatin foam, followed by silicone oil injection into the vitreous cavity. Post operative outcome was good with restoration of anatomical integrity of the globe along with improvement in visual acuity upto 6/18. Highlights: Gelatin foam being absorbable and inciting less reaction aids in sealing the perforation and maintenance of globe contour with the advantage being readily available, cost?effective and it can be left in situ without the need for additional surgery for its removal. This would be of use in situations where the donor sclera is not readily available, and thus can be a potential alternative. However, further studies with larger sample size need to be done to evaluate and compare its effectiveness over donor scleral grafts

Ocular occlusions in two cases of COVID-19

In late 2019, we saw the emergence of a new coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS?CoV?2), which rapidly evolved into a global pandemic. We report two cases of ocular vascular occlusion related to coronavirus disease 2019 (COVID?19) disease. The first case is of choroidal artery occlusion, while the second case is of combined central retinal artery and vein occlusion (CRAO and CRVO). We performed a thorough literature search and to the best of our knowledge, neither any of the above said has been reported in COVID?19–positive patients.

Not-so-minimal for minimally invasive surgery

Sub?macular hemorrhage poses a potential threat to vision if left untreated. The preferred surgical technique to clear sub?macular hemorrhage includes vitrectomy followed by retinotomy using a 41G needle with subsequent injection of recombinant tissue plasminogen activator (r?tPA) followed by air/SF6 injection into the sub?retinal space. A malleable nature, increased resistance, and the cost of the 41G needle limit its use. We evaluated the safety and efficacy of a 26G needle for retinotomy as a supplement for the 41G needle in a series of six subjects with sub?macular hemorrhage. A slight modification in the procedure was done by injecting air into the sub?retinal space prior to the r?tPA injection. We found that our technique of using the 26G needle for retinotomy is safe and effective due to its stable nature and self?sealing properties. An air injection prior to r?tPA allows for increased bioavailability of the drug by preventing efflux due to its tamponading effect.

Coats’ disease – Prognostic factors for globe and vision salvage in children, a long-term experience

Coats’ disease is associated with poor outcomes, and there are limited studies on long?term outcomes of Coats’ disease. The purpose of our study is to identify various predictive factors to help in prognosticating the treatment outcomes in advanced Coats’ disease in children. Methods: This is a retrospective case series from a single tertiary eye care center of children (<18 years) diagnosed with coat’s disease. Sixty?seven patients with Coat’s disease were identified from the medical records from 2009 to 2020. Patients’ demographic data, clinical presentation, stage, extent of involvement, detailed treatment history, clinical sequelae post?treatment (including complications and anatomical and functional outcomes) were noted. Binary logistic regression was performed to correlate the predictive factors for anatomical and functional improvement. Results: Of the 67 patients, 51 eyes of 51 patients were included in the study. The male to female proportion was 2.2. Mean age at presentation was 4.98 ± 3.55 years (range: 2 months–15 years). Mean duration of follow?up was 31.53 ± 26.38 months. Overall, our globe salvage rate was 92.2%. We found that vitreoretinal fibrosis (P < 0.001), subretinal gliosis (P < 0.001), vitreous hemorrhage (P = 0.02), tractional or combined retinal detachment (P < 0.001), foveal scar (P < 0.006), and cataract (P < 0.001) to be important factors to affect the outcome. Conclusion: Advanced stage of presentation (stage 3B and above), diffuse involvement, cataract, vitreoretinal fibrosis (preretinal and subretinal), vitreous hemorrhage, tractional or combined retinal detachment, and anterior hyaloid proliferation are poor prognostic factors for globe salvage in advanced disease. Subretinal gliotic nodule or scar and lack of visual rehabilitation suggest poor functional outcomes

Computer Game-Based Rehabilitation For Poststroke Upper Limb Deficits- Systematic Review And Meta-Analysis

Background: The need for intense rehabilitation protocols with easy applicability to improve for patient adherence and harness the potential neuroplasticity leading to improvement in the quality of life (QOL) in post-stroke patients. Several studies have described the benefits of virtual reality and video games in rehabilitation. Aims: To explore and determine if Computer game-based rehabilitation for post-stroke upper limb deficits after stroke is superior to conventional therapy in terms of (1) ICIDH based outcomes (2) Intervention duration (3) acceptability and adherence to the intervention. Methods: This systematic review and meta-analysis followed PRISMA guidelines. Several electronic databases were searched using specific keywords, to measure the effects of computer-game-based therapy in post-stroke patients compared to conventional therapy. Results: 14 studies were included after a systematic review, out of which 11 were included for analysis. Studies recording Wolf motor function test and box and block test have shown improvements with Computer-game-based therapy in addition to conventional therapy. No improvements were recorded in impairments and patient participation/Quality of life. CGBT was acceptable and reported no adverse effects. Conclusions: Computer-game-based therapy or non-immersive virtual rehabilitation is effective and acceptable for upper limb rehabilitation after stroke. With significant improvement in ‘activity-limitation,’ this mode of rehabilitation can be adapted for patient-specific needs. Its effects on impairment and quality of life need further exploration.

Knowledge And Awareness Of Probiotics Among The Dental Students In Thodupuzha-A Questionnaire Study

INTRODUCTION : Probiotics can be defined as living microbes,or as food ingredients containing living microbes, that beneficially influence the health of the host.the use of probiotic is said to be an imperative aspect in dentistry in prevention and treatment of caries,periodontal disease etc. AIM : This study aims to assess the knowledge and awareness of probiotics among dental students. METHODS : A total of 60 students from third year,final year and interns were surveyed regarding the knowledge of probiotics.A well structured and administered questionnaire including 12 questions was used to elicit the responses.the study was conducted during 2018–19 .Statistical analysis was done using descriptive statistics. RESULT : In this research majority of participants are third years.Study reveals 66% of participants are aware of the term probiotics and 75% of them agree probiotics are safe. CONCLUSION : It was reported that 83% of students were aware about the role of probiotics in improving the health, and majority of them willing to have it if it is recommended by professionals.

Knowledge And Awareness Of Probiotics Among The Dental Students In Thodupuzha-A Questionnaire Study

INTRODUCTION : Probiotics can be defined as living microbes,or as food ingredients containing living microbes, that beneficially influence the health of the host.the use of probiotic is said to be an imperative aspect in dentistry in prevention and treatment of caries,periodontal disease etc. AIM : This study aims to assess the knowledge and awareness of probiotics among dental students. METHODS : A total of 60 students from third year,final year and interns were surveyed regarding the knowledge of probiotics.A well structured and administered questionnaire including 12 questions was used to elicit the responses.the study was conducted during 2018-19 .Statistical analysis was done using descriptive statistics. RESULT : In this research majority of participants are third years.Study reveals 66% of participants are aware of the term probiotics and 75% of them agree probiotics are safe. CONCLUSION : It was reported that 83% of students were aware about the role of probiotics in improving the health, and majority of them willing to have it if it is recommended by professionals.

A preliminary study on the association of single nucleotide polymorphisms of interleukin 4 (IL4), IL13, IL4 receptor alpha (IL4Rα) & Toll-like receptor 4 (TLR4) genes with asthma in Indian adults.

Background & objectives: Interleukin 4 (IL4) and IL13 genes are believed to be responsible for inflammation of the airways in asthmatics. These share a common receptor component called IL4Rα which is another potentially important candidate gene linked to asthma phenotypes. Another gene Toll-like receptor 4 (TLR4) might affect the incidence or progression of asthma through the expression of proinflammatory genes. Several single nucleotide polymorphisms (SNPs) in IL4, IL13, IL4Rα and TLR4 have been reported to be linked to asthma or related phenotypes in several ethnic populations using linkage studies and association studies. However, the results have not been consistent. We investigated five SNPs (C-589T and C-33T of IL4, G+2044A of IL13, A+1902G of IL4Rα, and A+896G of TLR4) in patients with adult onset asthma to evaluate their role in manifestation and severity of asthma. Methods: Adult (>18 yr of age) patients with asthma (n=100) and healthy controls (n=50) were included in the study. Genotyping was performed using sequenom MassARRAY technology. Results: The mutant alleles of the C-589T and C-33T SNPs in the promoter region of IL4 were present in 4 per cent patients with asthma but absent from the control group suggesting that the variations in IL4 may contribute to asthma occurrence. The SNPs of other genes were seen in both controls and patients. Interpretation & conclusions: The results suggest the possible association between the genetic distribution of C-589T and C-33T SNPs of IL4 with asthma in Indian adults.

Unconventional techniques of fundus imaging: A review.

The methods of fundus examination include direct and indirect ophthalmoscopy and imaging with a fundus camera are an essential part of ophthalmic practice. The usage of unconventional equipment such as a hand‑held video camera, smartphone, and a nasal endoscope allows one to image the fundus with advantages and some disadvantages. The advantages of these instruments are the cost‑effectiveness, ultra portability and ability to obtain images in a remote setting and share the same electronically. These instruments, however, are unlikely to replace the fundus camera but then would always be an additional arsenal in an ophthalmologist’s armamentarium.

Formulation development and characterization of fast dissolving tablets of oxcarbazepine.

The objective of this study was formulation development and evaluation of Oxcarbazepine Fast Dissolving Tablets (FDTs) prepared by sublimation technique where different sublimating agents like camphor and menthol were used with L-HPC and crospovidone as a superdisintegrants. Oxcarbazepine is an anticonvulsant drug used in the treatment of epilepsy and bipolar disorder. Each sublimating agent was used in concentration of 10-20 mg per tablet. Tablets were first prepared and then kept in hot air oven for sublimation. The prepared FDTs were evaluated for weight variation, thickness, drug content, friability, hardness, wetting time, water absorption ratio, in-vitro dispersion time, in-vitro disintegration time and in-vitro dissolution time. All formulations showed disintegration time ranging from 8 to 332sec. Optimized batch (SA6) was selected for the stability studies. The results of stability studies revealed that there was no remarkable difference in the tested parameters of promising formulation after storage for 3 months at 400 c ± 20 c 75% ± 5%RH and at room temperature 65% ± 5%RH as compared to initial results All the prepared formulae complied with Pharmacopoeia requirements of drug contents.

Brachytherapy, A viable option of globe salvage in treatment of large ciliary body melanocytoma.

We report a case of large histopathologically proven melanocytoma of the ciliary body in a 15‑year‑old male, presented with rapid extraocular growth following incisional biopsy with scleral patch graft. We chose brachytherapy with Ruthenium 106 plaque over enucleation as the later was refused by the parents. The initial apical height of the tumor was 14.2 mm on ultrasonography. Two weeks after brachytherapy, the mass regressed to a size of 8.1 mm and 1 year later to 6.7 mm. This is the first case report showing the response of brachytherapy to ciliary body melanocytoma, which results in ocular and visual acuity salvation with considerable decreased in size of the tumor. The authors conclude that brachytherapy is an option in the management of non‑resectable melanocytoma of the ciliary body.

Brachytherapy, A viable option of globe salvage in treatment of large ciliary body melanocytoma.

We report a case of large histopathologically proven melanocytoma of the ciliary body in a 15‑year‑old male, presented with rapid extraocular growth following incisional biopsy with scleral patch graft. We chose brachytherapy with Ruthenium 106 plaque over enucleation as the later was refused by the parents. The initial apical height of the tumor was 14.2 mm on ultrasonography. Two weeks after brachytherapy, the mass regressed to a size of 8.1 mm and 1 year later to 6.7 mm. This is the first case report showing the response of brachytherapy to ciliary body melanocytoma, which results in ocular and visual acuity salvation with considerable decreased in size of the tumor. The authors conclude that brachytherapy is an option in the management of non‑resectable melanocytoma of the ciliary body.

Fundus imaging with a mobile phone: A review of techniques.

Fundus imaging with a fundus camera is an essential part of ophthalmic practice. A mobile phone with its in‑built camera and flash can be used to obtain fundus images of reasonable quality. The mobile phone can be used as an indirect ophthalmoscope when coupled with a condensing lens. It can be used as a direct ophthalmoscope after minimal modification, wherein the fundus can be viewed without an intervening lens in young patients with dilated pupils. Employing the ubiquitous mobile phone to obtain fundus images has the potential for mass screening, enables ophthalmologists without a fundus camera to document and share findings, is a tool for telemedicine and is rather inexpensive.

Immediate Loading of Dental Implants : A Review - Part I.

The ideal goal of prosthetic dentistry is to restore the form and function of the missing structures as close to natural as possible. The introduction of implants have revolutionized the field of restorative dentistry and this article evaluates the merits and demerits of the immediate loading implants

Brachytherapy of intra ocular tumors using ‘BARC I-125 Ocu-Prosta seeds’: An Indian experience.

Aim: To report our experience of brachytherapy using ‘BARC I‑125 Ocu‑Prosta seeds’ for the management of intraocular tumors with regard to tumor control, globe preservation visual outcome, and patient survival at Sankara Nethralaya, Chennai, India between September 2003 and May 2011. Materials and Methods: We reviewed records of 35 eyes of 35 patients who underwent ophthalmic brachytherapy between September 2003 and May 2011. Twenty‑one cases had choroidal melanoma, nine had childhood retinoblastoma, two had adult‑onset retinoblastoma, and there were one case each of vasoproliferative tumor, retinal angioma, and ciliary body melanoma. Brachytherapy was administered using a 15‑ or 20‑mm gold plaque with or without a notch. Brachytherapy was the primary treatment modality in all tumors other than retinoblastoma, wherein brachytherapy was done post chemoreduction for residual tumor. Results: For choroidal melanomas, the mean radiation dose was 68.69 ± 15.07 (range, 47.72-94.2) Gy. The eye salvage rate was 13/20 (65%) and tumor control rate was 16/20 (80%) at an average follow‑up of 24.43 ± 24.75 (range, 1.5-87.98) months. For retinoblastoma, the mean dose was 45.85 ± 3.90 (range, 39.51-50.92) Gy. The eye salvage rate and tumor control rate was 5/6 (83.3%) at an average follow‑up of 38.36 ± 31.33 (range, 4.14-97.78) months. All eyes with retinoblastoma needed additional focal therapy for tumor control and eye salvage. Conclusion: The results of this retrospective study confirms that the use of ‘BARC I‑125 Ocu‑Prosta seeds’ in episcleral plaques to treat intraocular tumors offers a viable option for the management of intraocular cancers.

Association of socio-economic status with family history in adult patients with asthma.

Background & objectives: Socio-economic status is associated with increased morbidity in patients with asthma. The aim of the present study was to assess the association between socio-economic status and family history of asthma in adult asthma patients. Methods: The study included 200 adults with asthma and 400 non-asthmatic controls. Socio-economic status was determined based on income. Regression analysis was used to estimate odd ratios in relation to socio-economic class, using age, gender, family history of asthma and smoking habits. Results: The highest occurrence of having any family history of asthma was observed in the high class group (88.2%), followed by upper middle class (79.5%), lower middle class (60%) and the lowest in the low class group (34%). Having any family history of asthma was an important risk factor in both univariate and multivariate analyses in lower middle class, upper middle class and high class, but not in the low class group. Interpretation and conclusions: The results indicated a positive association between having a family history of asthma and higher socio-economic status. Further studies on a large representative sample need to be conducted to confirm these findings.